Slip and Fall QC Report

Questionable Slip-and-Fall Claims Increase 12 Percent

Small Retailers May Be Prime Targets

DES PLAINES, Ill., May 8, 2012 – One of the most popular examples used by the insurance industry to describe fraud is the manufactured slip-and-fall injury. Just the mention of the term conjures up images of a person writhing in pain on the floor of a supermarket while pointing a blaming finger at a nearby banana peel.

Without any doubt these kinds of accidents occur and innocent people sustain serious injuries as a result. That’s why most people and business owners carry insurance—to financially protect them and innocent victims should such an accident occur.

Unfortunately, there is a criminal element that sees slip-and-falls as an easy way to obtain money. While their acting skills are substantial, their ethics are not and all of us end up subsidizing their fraudulent income by paying more for goods and services.

What exactly is a fraudulent slip-and-fall claim? It is a claim where a person creates a false and potentially dangerous situation with the intent to fake a slip or fall for monetary gain.

Although many of these incidents are attempted against large businesses, NICB has learned of several attempts to extort money from small retail operators using the threat of slip-and-fall litigation to obtain cash payments from shop owners. In this example, a slip-and-fall artist fakes an injury at a small retail shop then tells the store owner that he will need medical treatment.

After a period of time, the “injured” person returns to the store to inform the shopkeeper that his out-of-pocket medical bills were, say, $1,500 and that he has no choice but to sue for reimbursement. At some point the store owner is told that he can pay that amount in cash to the victim and the victim will consider it a closed matter. This “pay-and-forget” option is often viewed by shopkeepers as an easy way out of a potentially costly mess. Unfortunately, it encourages more fraud.

Most of these slip-and-fall extortions are never reported to law enforcement or to insurance companies making it very difficult to gauge the extent of the problem.

In this report, NICB reviewed slip-and-fall questionable claims referred during the period of 1/1/2010 – 12/31/2011. In 2010, there were 1,944 referrals; in 2011, there were 2,168—an increase of 12 percent.

The five states generating the most slip-and-fall questionable claims from 2010-2011 were: California (667); New York (280); Texas (245); Illinois (230) and Florida (286). The five cities were: New York (134); Los Angeles (127); Philadelphia (99); Chicago (63) and Las Vegas (62).

Anyone with information concerning slip-and-falls or other kinds of insurance fraud can report it anonymously by calling toll-free 1-800-TEL-NICB (1-800-835-6422), texting keyword “fraud” to TIP411 (847411) or by visiting our Web site at www.nicb.org. Or, iPhone or iPad users can download the NICB Fraud Tips to make it easy to quickly send a tip and get a response.

About the National Insurance Crime Bureau: headquartered in Des Plaines, Ill., the NICB is the nation’s leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy and public awareness. The NICB is supported by more than 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote over $339 billion in insurance premiums in 2011, or approximately 80 percent of the nation’s property/casualty insurance. That includes more than 94 percent ($156 billion) of the nation’s personal auto insurance. To learn more visit www.nicb.org.